Appropriate antibiotic prescribing in Community-Acquired Pneumonia in a Norwegian hospital setting

Abstract

Appropriate antibiotic prescribing is associated with favourable levels of antimicrobial resistance and clinical outcomes. Literature has indicated that antibiotic treatment of hospitalised patients with community-acquired pneumonia (CAP), the leading cause of death due to infection in adults worldwide, have potential for improvement. The overall aim of this PhD-work has been to promote appropriate antibiotic prescribing in hospitalised patients with CAP. We have developed and validated a Medication Assessment Tool for CAP (MAT-CAP) for retrospective audit of antibiotic prescribing at the University Hospital North Norway (UNN). Consequently, using this tool, areas with low and high quality of prescribing can be identified. Further, we have explored the association between adherence to Norwegian guideline recommendations and mortality, risk of readmission and prolonged length of stay for inpatients with CAP. We identified that adherence to guideline on empirical antibiotic was high, safe and associated with reduced risk of readmission to hospital within 30-days in a selective group of CAP-patients admitted to UNN. Our findings support the Norwegian guideline recommendations, and demonstrate the importance of having guidelines adapted to local and national levels of antimicrobial resistance. Third, in an intervention study we tailored improvement in antibiotic prescribing. The prescribing of appropriate empirical antibiotics increased substantially as a consequence of the intervention, and the effect sustained six months post intervention. However, for reducing total treatment duration and achieving dosage optimization of benzylpenicillin additional prospective interventions are warranted.